Menopausal hot flashes and insulin resistance

Polyphenolic-rich Cissus quadrangularis extract ameliorates insulin resistance by activating AdipoR1 in peri-/post-menopausal rats

Insulin resistance (IR) is a significant complication in menopausal women, which predisposes them to cardiovascular disorder, obesity, and diabetes. Cissus quadrangularis is a polyphenolic plant rich in nutrients and is used as an edible vegetable in Nigeria. Previously, we investigated that C. quadrangularis extract (EECQ) treatment ameliorates IR, hyperlipidemia, and overweight in diabetic rats. Accordingly, in the current study, we further evaluated the adiponectin mimetic activity of EECQ in peri-/post-menopausal rats. Perimenopause was induced by High-fat diet/4-vinylcyclohexenediepoxide/(HFD-VCD), while postmenopause was by HFD/bilateral ovariectomy (HFD-OVX). Both the menopausal rats demonstrated an abnormal level of sex hormones, IR, hyperlipidemia, increased fat mass, and abnormal weight gain. Nevertheless, EECQ treated group revealed protection from these untoward complications. Furthermore, the docking score of major constituents of EECQ on adiponectin receptor 1 (AdipoR1) depicted a strong binding affinity, which was comparable to the ligand adipoRon. Besides, AdipoR1 expression determined by RT-PCR, Western blotting, and immunohistochemistry was downregulated in peri-/post-menopausal rats. Similarly, the expression of AdipoR1 downstream marker APPL1 and insulin sensitivity markers, including IRS1, Akt1, and GLUT4, were also dysregulated in menopausal rats. However, EECQ treated rats manifested restoration of normal expression of APPL1, IRS1, Akt1, and GLUT4 by upregulating AdipoR1. Altogether, the current study promulgated the adiponectin mimetic activity of EECQ, which is substantial to mitigate IR in menopausal conditions.

Vasomotor symptom characteristics: are they risk factors for incident diabetes?

OBJECTIVE

Vasomotor symptoms (VMS), encompassing hot flashes and night sweats, may be associated with diabetes, but evidence is limited. We sought to estimate these associations.

METHODS

Among 150,007 postmenopausal Women's Health Initiative participants from 1993 to 2014, we prospectively examined associations of incident diabetes with VMS characteristics at enrollment: any VMS, severity (mild/ moderate/severe), type (hot flashes/night sweats), timing (early [premenopausal or perimenopausal]/late [postmenopausal]), and duration. Cox proportional-hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Mean duration of follow-up was 13.1 years. VMS prevalence was 33%. Reporting any VMS was associated with 18% increased diabetes risk (95% CI 1.14, 1.22), which increased with severity (mild: HR 1.13, 95% CI 1.08, 1.17; moderate: HR 1.29, 95% CI 1.22, 1.36; severe: HR 1.48, 95% CI 1.34, 1.62) and duration (4% per 5 years, 95% CI 1.03, 1.05), independent of obesity. Diabetes risk was more pronounced for women reporting any night sweats (night sweats only: HR 1.20, 95% CI 1.13, 1.26; night sweats and hot flashes: HR 1.22, 95% CI 1.17, 1.27) than only hot flashes (HR 1.08, 95% CI 1.02, 1.15) and was restricted to late VMS (late: HR 1.12, 95% CI 1.07, 1.18; early and late: HR 1.16, 95% CI 1.11, 1.22; early: HR 0.99, 95% CI 0.95, 1.04).

CONCLUSIONS

VMS are associated with elevated diabetes risk, particularly for women reporting night sweats and postmenopausal symptoms. The menopause transition may be an optimal window for clinicians to discuss long-term cardiovascular/metabolic risk with patients and leverage the bother of existing symptoms for behavior change to improve VMS and reduce diabetes risk.

Vasomotor symptoms and metabolic syndrome

A vast majority of menopausal women suffer from vasomotor symptoms, such as hot flushes and night sweats, the mean duration of which may be up to 7-10 years. In addition to a decreased quality of life, vasomotor symptoms may have an impact on overall health. Vasomotor symptoms are associated with overactivity of the sympathetic nervous system, and sympathetic overdrive in turn is associated with metabolic syndrome, which is a known risk factor for cardiovascular disease. Menopausal hot flushes have a complex relationship to different features of the metabolic syndrome and not all data point towards an association between vasomotor symptoms and metabolic syndrome. Thus, it is still unclear whether vasomotor symptoms are an independent risk factor for metabolic syndrome. Research in this area is constantly evolving and we present here the most recent data on the possible association between menopausal vasomotor symptoms and the metabolic syndrome.

Early severe vasomotor menopausal symptoms are associated with diabetes

OBJECTIVE

The purpose of this study was to investigate associations between profiles of vasomotor menopausal symptoms (VMS) during the menopausal transition with the prevalence of diabetes.

METHODS

VMS and diabetes were measured at baseline and 3-year intervals for 15 years in 4,895 women in the Australian Longitudinal Study on Women's Health who were aged 45 to 50 years at baseline in 1996. Latent class analysis and generalized estimating equation models for binary repeated measures were performed. The VMS profiles were labeled as mild, moderate, early severe, and late severe.

RESULTS

The prevalence of diabetes in the total group was 9.0%. Compared with mild VMS, the odds of diabetes were higher in those with a late severe profile (though not statistically significant; adjusted odds ratio, 1.28; 95% CI, 0.97-1.68) and in those with an early severe profile (adjusted odds ratio, 1.67; 95% CI, 1.20-2.32). Adjustment for body mass index attenuated this association, but the odds of diabetes were still significantly higher in women with an early severe profile than in women with mild VMS (odds ratio, 1.55; 95% CI, 1.11-2.17). The moderate profile was not associated with diabetes.

CONCLUSIONS

Women with an early severe VMS profile are more likely to have diabetes across a period of 15 years. This association is not explained by body mass index or other potential confounders. Our findings imply that the predictive value of VMS for diabetes may vary with the timing of VMS relative to menopause.

Effect of aging, glucose level, and HIV viral load on response to treatment with pegylated interferon plus ribavirin in HIV/HCV co-infected women

BACKGROUND

This was a post-hoc analysis of the Optimized Pegylated interferons Efficacy and anti-Retroviral Approach (OPERA) study, originally designed to document routine clinical and treatment data in HIV/HCV coinfected patients treated with pegylated interferon/ribavirin (PEG-IFN/RBV). The aim of this study was to define the impact of several variables, such as age, glucose metabolism, and HIV viral load, on PEG-IFN/RBV treatment outcomes, in HIV/HCV coinfected women.

METHODS

Female subjects from the OPERA database were retrospectively evaluated and factors associated with sustained virological response (SVR) were assessed and compared to the male population by logistic regression analysis. At baseline, clinical and demographic data were collected. Patients were then administered with PEG-IFN/RBV therapy for 48 weeks. After a 24-week follow-up period, SVR was evaluated.

RESULTS

A total of 1523 patients were enrolled in 98 centers across Italy, 1284 of whom were IFN therapy naïve and were included in the post-hoc analysis. In the female group, factors associated with SVR were the presence of HCV genotype 2,3 (adjusted odds ratio [AOR]=6.87, p<0.0001), age ≤45 years (AOR=2.61, p=0.014), ≥80% exposure to PEG-IFN (AOR=3.85, p=0.019) and RBV (AOR=3.94, p=0.015) therapy. Also, increased glucose plasma level negatively correlated with SVR (AOR=0.98, p=0.066). In the male population, undetectable HIV-RNA (AOR=1.47, p=0.033) but not glucose level (AOR=1.0, p=0.95) predicted SVR.

CONCLUSIONS

Findings from the present study demonstrate that several factors may be predictive of SVR when pegylated interferon plus ribavirin is used (i.e., age, gender, HIV viral load and HCV genotype) that need to be carefully considered prior to therapeutic intervention, since they may hinder successful therapy. Use of PEG-IFN/RBV with novel direct antiviral agents will likely be still maintained until less expensive and effective interferon-free strategies become available.

The association between vasomotor symptoms and metabolic health in peri- and postmenopausal women: a systematic review

The objective of this study was to systematically review studies describing the association between vasomotor symptoms and metabolic syndrome, type 2 diabetes and insulin resistance in peri- and postmenopausal women. A systematic search of studies was performed in EMBASE, MEDLINE, Web-of-science, Scopus, PubMed publisher, Cochrane Library, Google scholar. To identify studies eligible for inclusion, the following criteria were defined: randomised trials, cohort, case-control, and cross-sectional studies investigating the association between vasomotor symptoms and metabolic syndrome, type 2 diabetes and insulin resistance in peri- and postmenopausal women with natural menopause. Methodological quality was assessed using a modified NewCastle Ottawa Assessment Scale. After screening 2660 titles and abstracts, four studies, of which two cohort studies met the criteria of high methodological quality, were included in the review. Because of the heterogeneity and the limited number of studies, there is no sufficient evidence on the potential role of vasomotor symptoms in metabolic health. However, both high-quality cohort studies, with large study populations and adjustment for multiple confounding variables showed positive associations between vasomotor symptoms and insulin resistance and type 2 diabetes mellitus. These findings suggest that there is an association between vasomotor symptoms and metabolic health outcomes. To confirm this and to strengthen the evidence, more high quality longitudinal research on this topic is needed.

Risk factors for night sweats and hot flushes in midlife: results from a prospective cohort study

OBJECTIVE

This study aims to identify social, lifestyle, and reproductive history risk factors for night sweats (NS) only, hot flushes (HF) only, and both NS and HF.

METHODS

Risk factors and symptoms among 10,454 participants of the Australian Longitudinal Study on Women's Health who were aged 45 to 50 years in 1996 were measured at baseline and 3-year intervals (surveys 2-6) for 15 years. Multinomial logistic regression analyses were performed.

RESULTS

Compared with neither symptom, both symptoms together were reported less often by highly educated women (odds ratio, 0.61; 99.9% CI, 0.50-0.74), but more often by women who were heavier (odds ratio, 1.23; 99.9% CI, 1.08-1.40), were current smokers (odds ratio, 1.31; 99.9% CI, 1.09-1.56), were high-risk drinkers (odds ratio, 1.44; 99.9% CI, 1.10-1.89), were perimenopausal (odds ratio, 6.57; 99.9% CI, 5.52-7.82) or postmenopausal (odds ratio, 4.74; 99.9% CI, 4.00-5.63), had gained weight (odds ratio, 1.15; 99.9% CI, 1.01-1.31), or had premenstrual tension (odds ratio, 1.86; 99.9% CI, 1.48-2.34), than by women without these characteristics. HF only was reported less often by highly educated women (odds ratio, 0.73; 99.9% CI, 0.59-0.90), but more often by perimenopausal (odds ratio, 3.58; 99.9% CI, 2.95-4.35) or postmenopausal (odds ratio, 2.97; 99.9% CI, 2.47-3.57) women and by those with premenstrual tension (odds ratio, 1.60; 99.9% CI, 1.25-2.04). Finally, NS only was reported more often among current smokers (odds ratio, 1.55; 99.9% CI, 1.11-2.19), high-risk drinkers (odds ratio, 1.76; 99.9% CI, 1.04-2.97), perimenopausal women (odds ratio, 1.53; 99.9% CI, 1.14-2.06), those with diabetes (odds ratio, 1.91; 99.9% CI, 1.08-3.35), those with premenstrual tension (odds ratio, 1.67; 99.9% CI, 1.09-2.56), or those of early age at first pregnancy (odds ratio, 1.45; 99.9% CI, 1.05-1.99).

CONCLUSIONS

The presence of both symptoms is associated with social, behavioral, and menstrual factors. Some differences in risk factors among women who report only one symptom or both symptoms are observed, suggesting a slightly different etiology for each.

Risk factors, pathophysiology, and treatment of hot flashes in cancer

Hot flashes are prevalent and severe symptoms that can interfere with mood, sleep, and quality of life for women and men with cancer. The purpose of this article is to review existing literature on the risk factors, pathophysiology, and treatment of hot flashes in individuals with cancer. Electronic searches were conducted to identify relevant English-language literature published through June 15, 2012. Results indicated that risk factors for hot flashes in cancer include patient-related factors (eg, age, race/ethnicity, educational level, smoking history, cardiovascular risk including body mass index, and genetics) and disease-related factors (eg, cancer diagnosis and dose/type of treatment). In addition, although the pathophysiology of hot flashes has remained elusive, these symptoms are likely attributable to disruptions in thermoregulation and neurochemicals. Therapies that have been offered or tested fall into 4 broad categories: pharmacological, nutraceutical, surgical, and complementary/behavioral strategies. The evidence base for this broad range of therapies varies, with some treatments not yet having been fully tested or showing equivocal results. The evidence base surrounding all therapies is evaluated to enhance hot flash treatment decision-making by clinicians and patients.